Anaesthetic protocol for small animal caesareans

RE: Anaesthetic protocol for small animal caesareans

Chris Linney — Fri, 07 Aug 2015 14:27:57 GMT

Hi All,

There is an interesting upcoming Webinar hosted by BSAVA (I'm not on commision!) on this very topic which came through the post on a flyer. Information here: http://www.bsava.com/CPD/Webinars.aspx

Chris

RE: Anaesthetic protocol for small animal caesareans

Martin Atkinson — Thu, 06 Aug 2015 18:30:08 GMT

Are you trying to invoke a reaction Anthony err Michael?

I don't think it matters what you use and often it is better the devil you know than the one you don't. But whatever I use I knock 'em down to effect so I can just intubate and then deepen the plain with Iso, with enough left in the syringe for a rapid top-up if necessary

RE: Anaesthetic protocol for small animal caesareans

karen jones — Thu, 06 Aug 2015 18:20:44 GMT

pricing it up looks like alfaxan is 4x price of propofol but have ordered some as will run out of propofol over weekend. its what youre used to and cost is an issue especially with price sensitive ops. We've done a dose chart and will have to see how it goes, though it looks like we wont have a choice.

us dinosaur vets were talking about getting thio if its still available but think it would give nurses heart attacks !

RE: Anaesthetic protocol for small animal caesareans

Michael Woodhouse — Thu, 06 Aug 2015 18:12:41 GMT

I've also used Alfaxan and much prefer propofol. Even for sick things or caesers.

For 95% of what we do I was actually very happy with 2.5% thio.........

RE: Anaesthetic protocol for small animal caesareans

Evelyn Barbour-Hill — Thu, 06 Aug 2015 14:40:46 GMT

[quote user="Hannah Wynne Richards"]

Propofol had to be given even more slowly try alfaxan, and you won't want to go back.

Wynne

[/quote]

Well, Ive used both and I'm very happy with propofol. I see no problems with it. I'll keep my bottle of alfaxan for casarean sections.

RE: Anaesthetic protocol for small animal caesareans

Martin Atkinson — Thu, 06 Aug 2015 14:15:58 GMT

[quote user="Hannah Wynne Richards"]

Propofol had to be given even more slowly try alfaxan, and you won't want to go back.

Wynne

[/quote]I did because it is so much more expensive than propofol even at half the recommended dose (at which it is still effective) and when you're competing with the cut-price boys down the road this is significant. And in general use I've found no advantage. Paradoxically the only time we really use it now is in very large dogs where I would need more than 20 ml of propofol in the syringe.(or caesarians)!

RE: Anaesthetic protocol for small animal caesareans

Hannah Wynne Richards — Thu, 06 Aug 2015 12:08:04 GMT

Propofol had to be given even more slowly try alfaxan, and you won't want to go back.

Wynne

RE: Anaesthetic protocol for small animal caesareans

Martin Atkinson — Thu, 06 Aug 2015 10:12:27 GMT

[quote user="bob lehner"]i think you will find the data sheets of all five UK licensed buprenorphine products say; 'The product should not be used pre-operatively in cases of Caesarean section, due to the risk of respiratory depression in the offspring periparturiently, and should only be used post-operatively with special care [/quote]I wonder how much of this is a knee jerk reaction to the previously mentioned case and simply because they have not done the research to prove its safe. Maybe I've been living in cloud cuckoo land but I have always understood that one reason for using morphine derivatives as pre-anaesthetic agents was because they don't cause respiratory depression.

RE: Anaesthetic protocol for small animal caesareans

Braden Collins — Thu, 06 Aug 2015 00:34:47 GMT

Alfaxan is very easy to use. Needs to be given slowly to avoid apnoea and you normally need less than the data sheet indicates. you can also give it IM to cranky cats. We use dia/ketamine for our routine ga's and alfaxan for everything even slightly higher risk. We no longer use propofol as alfaxan does everything we need. If your staff are worried about using it, try it on some cat desexing or small healthy dogs so the can get used to it with healthy animals.

RE: Anaesthetic protocol for small animal caesareans

karen jones — Wed, 05 Aug 2015 22:12:52 GMT

Seems propofol is unavailable at moment. Norbrook has had factory batch failure, abbots version not available until mid September and possibly some human sourced available next week. Only have 11 bottles left. Never used alfaxan which seems to be very expensive but maybe we will have to try it. There could be some stressed people around if it acts differntly to propofol

RE: Anaesthetic protocol for small animal caesareans

Mark Naguib — Wed, 05 Aug 2015 20:58:27 GMT

[quote user="Anthony Dennison"]

Because of this, I tend to induce straight with no premed, buprenorphine and a single shot of metacam when the pups are out.

[/quote]

I tend to do similar, however using Rimadyl instead of Metacam because the Metacam data sheet states "Do not use in pregnant or lactating animals." Analgesia is always discussed with the client (not that it's optional!) and they sign a disclaimer.

Have done a fair few caesars and never had a problem with not pre-meding either in terms of induction or recovery - always nice and smooth with Alfaxan - many don't even need the full dose.

RE: Anaesthetic protocol for small animal caesareans

bob lehner — Wed, 05 Aug 2015 20:37:14 GMT

[quote user="Laura Kidd"]It depends on which trade version of buprenorphine you use whether it is specifically contra-indicated e.g. buprenodale or a special warning e.g. vetergesic[/quote]

i think you will find the data sheets of all five UK licensed buprenorphine products say; 'The product should not be used pre-operatively in cases of Caesarean section, due to the risk of respiratory depression in the offspring periparturiently, and should only be used post-operatively with special care (see below).'

The WSAVA Guidelines are very interesting and seem to take a much more relaxed view of what can be used.

RE: Anaesthetic protocol for small animal caesareans

Laura Kidd — Wed, 05 Aug 2015 17:21:15 GMT

Current WSAVA guidance:

http://www.wsava.org/sites/default/files/Caesarean%20section.pdf

It depends on which trade version of buprenorphine you use whether it is specifically contra-indicated e.g. buprenodale or a special warning e.g. vetergesic

RE: Anaesthetic protocol for small animal caesareans

bob lehner — Wed, 05 Aug 2015 15:03:58 GMT

[quote user="Anthony Dennison"]wner of the bitch did some research, discovered buprenorphine isn't licensed in pregnant animals, and complained to the RCVS/sued or something along those lines. VDS paid out, as they didn't really have a defence.[/quote]

Not just 'isn't licensed' ..... but specifically contra-indicated on the data sheet 'The product should not be used pre-operatively in cases of Caesarean section, due to the risk of respiratory depression in the offspring periparturiently, and should only be used post-operatively with care.'

I guess that makes its use indefensible (although I have seen it used numerous times in the past, with no apparent ill-effects).

RE: Anaesthetic protocol for small animal caesareans

Martin Atkinson — Wed, 05 Aug 2015 13:25:00 GMT

[quote user="Anthony Dennison"]Within the last 2 years there was a VDS claim where a caesarian had been given a buprenorphine pre-med, and then all the pups died. Owner of the bitch did some research, discovered buprenorphine isn't licensed in pregnant animals, and complained to the RCVS/sued or something along those lines. VDS paid out, as they didn't really have a defence.[/quote]I'd be pretty sure the buprenorphine had no on impact this. Simply a case of a vindictive owner using the letter of the law to enhance their claim. A defeat for common sense unfortunately.

RE: Anaesthetic protocol for small animal caesareans

Michael Woodhouse — Wed, 05 Aug 2015 09:50:36 GMT

I personally won't induce with no premed. We always used medetomidine/butorphanol but have switched to methadone/medetomidine now after the VDS thing. Induce with propofol.

Always add to the consent form that some medicines used are not licensed in caesers/pregnancy but in dogs best interest. Pre op NSAID (carprofen).

Give pups a tiny drop of atipamezole afterwards.

Working in other practices I saw thio, propofol and alfaxan used with no pre-med. Seen bitches gassed down. Our recipe (similar to our usual GA recipe) is stress free for the bitch, good strong lively puppies and a smooth recovery for the bitch. I hated to see them bashing about with no pre med post op.

RE: Anaesthetic protocol for small animal caesareans

Anthony Dennison — Wed, 05 Aug 2015 09:30:29 GMT

Think there was a discussion about this on the forum a while back. Within the last 2 years there was a VDS claim where a caesarian had been given a buprenorphine pre-med, and then all the pups died. Owner of the bitch did some research, discovered buprenorphine isn't licensed in pregnant animals, and complained to the RCVS/sued or something along those lines. VDS paid out, as they didn't really have a defence.

Because of this, I tend to induce straight with no premed, buprenorphine and a single shot of metacam when the pups are out.

Perhaps doing a local anaesthetic block (splash block?) of the muscle layer on closure might help with analgesia?

RE: Anaesthetic protocol for small animal caesareans

Martin Atkinson — Wed, 05 Aug 2015 09:03:12 GMT

I haven't done a caesarian for ages but I would premed with buprenorphine or torbugesic and GA with Alfaxan. then maintain on Iso. Indeed I used to use Saffan in bitches when it was available and given them a shot of antihistamine to prevent the inevitable allergic response to it. Result: a stable anaesthetic and puppies crying as soon as they emerged.

RE: Anaesthetic protocol for small animal caesareans

Hannah Wynne Richards — Wed, 05 Aug 2015 08:40:13 GMT

Almost the same as Braden. My nurse would kill me if I suggested going back to propofol. Only difference is the methadone is given IM

Wynne

RE: Anaesthetic protocol for small animal caesareans

Braden Collins — Tue, 04 Aug 2015 23:36:42 GMT

We induce with alfaxsn, no premed. I would strongly recommend if over protocol As the pups come out very bright and lively. As soon as the last pup is out we give methadone IV plus a carprofen injection.

RE: Anaesthetic protocol for small animal caesareans

John Flynn — Tue, 04 Aug 2015 22:59:58 GMT

[quote user="Evelyn Barbour-Hill"]

[quote user="John Flynn"]PS - don't give propofol to cats - [/quote]

Why not?

[/quote]

The only study I'm aware of had much greater kitten mortality - of course this could be a myth handed down through the years and there may be some that get excellent results in decent numbers of cat caesareans with inclusion of propofol who could debunk it as a myth after all.

It's a bit hazy, with few details, but the offending abstract is the 7th one down in this list:

http://www.readcube.com/articles/10.1111%2Fj.1467-2995.1996.tb00294.x?r3_referer=wol&tracking_action=preview_click&show_checkout=1&purchase_referrer=onlinelibrary.wiley.com&purchase_site_license=LICENSE_DENIED

It's an abstract by Elvosson, Funkquist & Nyman from the 1996Journal of Veterinary Anesthesia . 7 times more kittens born dead with propofol/iso versus epidural - I don't think they included purely gasing down for comparison (but I'd blame the propofol personally), though xylazine/ketamine/medetomidine only caused a 5-6 times increase in dead kittens if that helps to put the propofol bit in perspective.

Like most things, once it's been "studied", it's unlikely to be studied better as I think most would consider using propofol to be a bad idea so couldn't bring themselves to try to replicate these findings etc in a fair comparison of propofol/iso versus iso alone for instance.

RE: Anaesthetic protocol for small animal caesareans

sam haig (Aldridge) — Tue, 04 Aug 2015 22:47:31 GMT

We induce with propfol, no premed. We are debating alfaxan instead. Isoflurane. Line block for analgesia, followed by methadone when pups are out. IV paracetamol if birch still painful on recovery (rare) we have been told that buprenorphine is a complete no as it is specifically contraindicated in the data sheet (if not in real life) and that because of this the VDS won't defend you in case of complaint where it has been used

RE: Anaesthetic protocol for small animal caesareans

Lauren Kirk — Tue, 04 Aug 2015 22:46:57 GMT

Thanks for your reply John. What is the theory behind not giving propofol to cats?

RE: Anaesthetic protocol for small animal caesareans

Evelyn Barbour-Hill — Tue, 04 Aug 2015 22:44:41 GMT

[quote user="John Flynn"]PS - don't give propofol to cats - [/quote]

Why not?

RE: Anaesthetic protocol for small animal caesareans

Lauren Kirk — Tue, 04 Aug 2015 22:42:40 GMT

Many thanks for your reply Catriona. The particular dog that sparked this debate was sent home on metacam (not by myself). Any thoughts on post op analgesia in nursing bitches?